What do you think about Obamacare?

I just clicked a few buttons to try to find out if $600 a month for a healthy 40 year old was a lot or not, as health insurance premiums go, and all I can say is... I give up. What a mess it all is. I looked here in the UK too, ready to bear in mind that the market here is skewed because private healthcare providers know they can always dump their patients on the NHS if they get too expensive, and I couldn't even get any sites to give me a price range. Unless you're prepared to go through the detailed quoting process (you must be joking, I'm not having that on my internet history) they ain't telling.

If it were, really were, a free market, then healthy comparatively affluent responsible middle aged (if I may say so without offence) adults should be extremely attractive to underwriters and your premiums should be accordingly low. It *should* be easy for insurers to offer you good terms, on the grounds that you're comparatively unlikely to cost them anything much. God willing, spit-spit-spit, and so on.

But between providers thinking they can think of a number and double it, basically, when the costs are being borne by insurers, and governmental restraints and impositions on the market, and the necessity to provide insurance for large numbers of people who are, in pure market terms, uninsurable, for all sorts of reasons... it's just a mess.

Stay well, Whirled. Can you get sensibly priced eye care and dental care and similar plans, and cover the essentials that way?

Whirled, That is what is wrong. It seems someone is always on the dirty end of the stick. It isn't right that people like you pay so much. It wasn't right that people working 2-3 jobs still couldn't get health care. It isn't right that before ACA no one would sell me insurance because of a preexisting condition. It made no difference that I did everything possible to keep it under control. Btw I am in a rural market and make just too much for subsidies. I pay $1200 monthly for just me. It is a serious hardship but I still am glad I can get it. I didn't vote for the current guy but I still hoped he would fulfill a promise and make it better. Instead everything proposed makes it worse. And now Medicare is threatened. I really don't know the answer.

Whirled, That is what is wrong. It seems someone is always on the dirty end of the stick. It isn't right that people like you pay so much. It wasn't right that people working 2-3 jobs still couldn't get health care. It isn't right that before ACA no one would sell me insurance because of a preexisting condition. It made no difference that I did everything possible to keep it under control. Btw I am in a rural market and make just too much for subsidies. I pay $1200 monthly for just me. It is a serious hardship but I still am glad I can get it. I didn't vote for the current guy but I still hoped he would fulfill a promise and make it better. Instead everything proposed makes it worse. And now Medicare is threatened. I really don't know the answer.

Careisgiving, Forbes was playing slightly fast-and-loose with that story. *One* health authority was in the headlines stating that patients who were smokers and/or obese would not be eligible for certain treatments, but for one thing there are sound clinical justifications for that, for another it's a stick to beat the several million fatty-puffs and stubborn smokers the Department of Health haven't yet bullied into reforming and gives the Treasury an excuse for taxing cigarettes and doughnuts even more, and for another if you actually break your hip or twang a knee ligament you'd still get treated - it's the elective joint surgeries they're talking about.

Rationing has been on the scene to my certain knowledge for over thirty years. Nurses have been threatening to leave nursing, and junior doctors have all said they're going to Australia, for the same length of time. The NHS is a cross between a bargain basement and a nuthouse. *But it always has been.* And *every year* its continual crises, financial and operational, are described as "unprecedented." In the nineties, Mr Mandela asked us to stop nicking South African nurses. In the noughties, there were scandals about poor English language skills, and tests were introduced, and then - surprise! - there was a scandal about exam-passing scams in the Philippines. ERs turning away patients and wards being shut down because of flu outbreaks are annual rituals, like the Christmas lights and roughly at the same time of year. Pre-Brexit, we were warned that the NHS depended on a quarter of a million EU citizens who'd chosen to come and work here out of the goodness of their hearts - nobody pointed out that represents a quarter of a million professional careers we have disgracefully failed to invest in. Nor that we steal even more of our overseas doctors from the Indian subcontinent anyway.

So all in all, no, it can't go on. But, God knows how, it does...

I think we should stop calling it Obama care. It is easier to be objective about the ACA if it isn't immediately associated with a particular politician.

It is amazing what can be accomplished if no one worries about who gets the credit or the blame.

Thank you CountryMouse and RosyDay for your replies! RosyDay, I'm sorry that your premiums are so high. That's outrageous!

CountryMouse, to answer your question, we pay out of pocket for eye and dental care as well. It's cheaper than paying the premiums.

Countrymouse: I understand. However, there are reports published in different news organizations as recent as last month (Sept 2017) discussing updates to the NHS decision to limit hip and knee surgeries for obese patients and for smokers. I'm definitely not in support of any type of institution imposing a ban for any reason, but it's very frightening, don't you think, that this is what NHS has decided to do to curb costs? And it simply won't stop there as everyone in every country on the planet is living longer. 99% of all obese patients and smokers are not limited by obesity and smoking as a standalone medical condition, many of these patients have extra costs associated with their illnesses such Type 2 diabetes management, varicose vein procedures due to poor circulation, heart stents, cancer, mobility issues/physical therapy, degenerative disc disease, side effects of long-term use of medications, etc. I see The NHS decision as not saving money by just limiting hip and knee surgeries, it's also addressing the costs of managing all lifelong health issues related to being obese or being a smoker.

My BCBS plan was grandfathered in before Obamacare. I pay $459/month for a PPO plan. My deductible is $5K. This exact same plan in the Obamacare market place would have cost me $680/month with a $10K deductible that includes services not applicable to my health and severely limits the pool of doctors I can see. Living in the USA, I don't want to be limited to see a doctor when I need to and I don't want to wait for months upon months for non-cancer surgery if I was living in The UK. I just don't want to be restricted in choices when it comes to my health and this is what the US healthcare system offers - though it's not perfect and has multiple hiccups - but it's a lot better than most of other countries. I know of multiple US residents living in Canada but will not renounce their US citizenship because come back to the US for their healthcare.

I'm all about insurance covering pre-existing conditions and us consumers subsidizing this cost. But 90% of our astronomical healthcare cost are simply not due to genetic conditions like Type 1 diabetes, epilepsy, Down Syndrome, etc, it's due to management of chronic diseases like cancer, Alzheimer's, Type-2 diabetes and all of its wide-ranging lifelong associated costs. The CDC just reported that 40% of cancers are due to lifestyle choices. Treating a patient with cancer and all of his lifelong complications is a lot more expensive on the healthcare system in the long run than treating a patient with any genetic condition for his lifetime. The overall cost of a chemotherapy drug from concept to research to development to marketing easily is a cost of - one billion dollars because it's a minimum of ten to twenty-year process from start to finish. The pharma company wants all of its investment back plus interest. I'm definitely not saying eating kale and grass every day will prevent cancer because there way too many variables involved in development of this disease, but it's been clinically proven that there is a link of cancer to obesity and to smokers. This is why I see many insurance companies in the next decade offering discounts to individuals who take responsibility in actively managing their health.

Yesterday the current President signed an Executive Order to what sounds like how health insurance worked before the Affordable Care Act [ACA].

Thus it sounds like the come back of "junk" health insurance where a person gets very inexpensive health insurance policy only to find out when they are in the hospital that the insurance covers just a tiny portion of the cost, and the rest is out-of -pocket. The ACA had put a squash on those types of policies as it didn't meet the ACA guidelines.

There was also mention yesterday of Federal/State subsidies that helped lower-income enrollees pay for health care, that the subsidies might end. Let's hope not.

I haven't heard if pre-existing conditions will remain as a coverage or will be tossed out. I remember decades ago trying to get health insurance back when doctors thought I had a wheat allergy, I was denied coverage, but eventually found a higher premium policy. Guess the insurance company thought I would OD on a loaf of bread :P

I had visions of insurance companies doing a history on each patient and if your parents had heart problems, cancer, diabetes, you could inherit those problems, thus be pre-existing.

Haven't heard if the "cap" would come back, meaning your health insurance would only pay up to a certain amount for your care. Thus if you have a major health issue and the cost had reached $200k, sorry you reached the "cap" limit. Let's hope not.

This will be a wait and see approach as to what will be coming down the pike.

The ACA has been sabotaged by conservative politicians from day one. Sure there were problems but millions of Americans got decent Heath insurance for the first time.

But even folks benefiting from the ACA were convinced by all the propaganda that it was some kind of evil government overreach.

Trump and his swamp critters are dismantling the remnants of ACA as I write. Making America great again.....

Quote: "Sure there were problems but millions of Americans got decent Heath insurance for the first time."

Windyridge, did you even READ my posts? And millions more can now no longer afford insurance!!!!!!!!!!!!!!! Obamacare is just a swap out, HOW IS THAT ANY BETTER??!? This is the kind of head in the sand thinking that drives me crazy!! I swear, if I hear just ONE more time, "Well at least other people have insurance now!" I'm going to lose my mind.

No I didn't read all your posts WT. but you seem even more outraged than I am. I don't think a debate between us will accomplish anything. I hope you didn't break your keyboard pounding in all those !!!!!!!!'

Just having fun. I respect your right to say what you please.

Whirled, you'll have to forgive the people in the group. Many are live-in caregivers who gave up jobs or started working part-time to take care of someone. A lot of people on the group don't have a good income now and I'm sure many are on Medicare or get insurance through the ACA. Many people have parents on Medicaid that could have been affected if either of the first two GOP plans had passed. This isn't a typical group, since people here tend to be more vested in the state of healthcare in the USA. There are so many ways that the healthcare system could have been fixed, but it is going to become more broken, I'm afraid.

WT; I feel for you, I really do. The folks I've heard from who were self employed before the ACA and who lost their low cost plans really got the shaft, it seems.

But, it also seems that many folks in your boat actually had not very good insurance back then, with many exclusions (at least that's what I've gathered from the folks I talked to; they had very basic plans that didn't cover much except catastrophic illnesses)

I have to say that I really, really believe that the only solution to this issue is a single payer system, with folks who are wealthy able to pay for "Rolls Royce" care in a private system if they care to. It's what exists in Western Europe and in Israel.

It is also the system in place in Canada. People can go to private doctors, but everyone has access to the state-run system. I have quite a few Canadian friends that are fairly well off who have told me the state system is fine with them. One friend even had a heart transplant two years ago using the state service. He is doing well. The Canadian system seems to work so much better than the UK system -- I don't know what the differences are. I know the Canadian system is very expensive to the government. I wouldn't be surprised if they don't have to scale it back in some way.

I have heard there can be a long wait time for elective surgeries in Canada, but not for needed surgeries. It seems to run about as good as a universal system can. I've heard that Australia and Japan are even better. 

Australia tchah! It's easy to provide a sleek efficient health service for fourteen people and a wallaby.

And I'm guessing - not to mention stereotyping - but I'll bet Japan benefits from the world's most compliant patient population. Still haven't got over the little old grandmother rescued at Fukushima that I saw on the news - she kept trying to get off her gurney to bow to her rescuers, Lord love her and bless her.

LOL

The federal subsidies were determined to be unconstitutional last February . They go bye bye today.
I am optimistic about today’s changes. I’m willing to support reform of the ACA as it wasn’t working. Monthly premiums are exorbitant; deductibles even higher.
The countries that have Universal don’t come close to the US population which is one reason single payer will never occur. It would be too expensive.
Poor people always had/have healthcare - it’s called Medicaid.
No one is denied care in US hospitals.
Why should the government pay subsidies to insurance companies? There are only about 3 now.
I think free market exchanges will be great. Competition is always good for the consumer.

--My daughter and her hubby are self employed with 3 kids. Their monthly premiums are $1400. They have to hit a out of pocket of $5000 per person before ANYTHING is covered. Then it's covered at 60% of the usual and customary fee.

She said last year they paid out of pocket over $40,000.

Obama care has nearly bankrupted them but they cannot do without it. They have a son with a heart condition and he MUST have yearly scans, etc.

My daughter has her own business, and every cent she makes goes towards paying premiums.

That is terrible. I have to admit that my experience with the ACA has not been too bad since the subsidies were in place for me. I chose a plan with a low deductible. The main trouble was that the last year bcbs narrowed the auxiliary service providers (e.g., labs, diagnostics) that I ended up paying for anything my doctor sent out. bcbs of Alabama also decided not to cover preventive services, e.g. mammograms, unless a lump was found first or there was a high family risk. :(

I am also self employed. I think much depends on which state a person lives in.

Yes the remaining insurance providers have begun to extensively narrow choices of what medications they will pay for, ancillaries (as stated above) and services in general. So with the ACA staying as it is, those providers would be able to maintain their monopoly, charge high monthly premiums, increase deductibles AND limit what kind of medication/ancillaries they will pay for. 
Both parties need to work together on this instead of one side or the other constantly bickering and stonewalling. Say what you want about our current President, he has focused on what he promised to do and is taking action & willing to give him a chance. 
Wow  Jessebelle, that is awful about the mammogram! This breaks my heart...
If I were a politician & had to chose to spend Federal/State monies on either free birth control or mammograms,  I would choose the latter. Birth control pills are relatively cheap, a screening mammogram that can save a woman’s life is priceless. 

Oo! Update in this morning's paper - perhaps Forbes have contacts in high places :) Note: I take what is supposed to be a respectable broadsheet daily. But in my view its "Health Editor" is one of the silliest journalists currently employed in the media.


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SMOKERS AND OBESE FACE INDEFINITE SURGERY BAN

The NHS will ban patients from surgery indefinitely unless they lose weight or quit smoking, under controversial plans being drawn up by officials.

[Really? Goodness! Tell me more...]

The restrictions in Hertfordshire last night came under attack from the Royal College of Surgeons. Ian Eardley, the senior vice-president, called for an "urgent rethink" of policies that he said were "discriminatory" and would leave patients in pain and misery. "Singling out patients in this way goes against the principles of the NHS," he said.

In recent years, patients in some areas have been given time to lose weight or quit smoking, but ultimately allowed surgery regardless. But the rules drawn up by clinical commissioning groups in Hertfordshire say that obese patients "will not get non-urgent surgery until they reduce their weight" at all, unless the circumstances are exceptional.

The criteria, revealed in the 'Health Service Journal', also means [sic] smokers will only be referred for operations if they have quit for at least eight weeks.

East and North Hertfordshire CCG and Herts Valleys CCG said the plans were aimed at encouraging people "to take more responsibility" whilst "freeing up limited NHS resources for priority treatment."

Joyce Robins, from Patient Concern, said: "This is absolutely disgraceful - we all pay our taxes; we did not agree to a two-tier system."

****************
So, indefinite surgery ban? Really?? No, not really. As you were.

Back in the day we used to say these type people had a corn cob up their butt. I don't know what the UK needs to do. The government there always seems to be wailing that the NHS is destroying the country. What in the world could be going on with them? I've heard many in the UK have been eyeing the system in the US with envy. The US system is one that takes money from the poor and gives it to the rich. 

Oh, it's not the governments complaining! No no, perish the thought! "The NHS is safe in our hands" "we are investing record amounts in improving care"; or "thirty days to save the NHS!" was one pre-election slogan. And "pay tribute to our hard-working nurses and NHS" workers is as much a part of every speech as "good evening ladies and gentlemen."

The trouble is that each political party believes that the electorate is so tearfully attached to an all-caring all-embracing health care system that it can't add. And so far, they have been proved correct.

Obama care is great for lower income families. Makes health insurance a God send and very affordable. If you make a good income then you will pay more for health insurance. You want be able to buy the second 50,000 car. If you have a very good income then you want be about to buy the second 100,000 car. If you have a very very good income (millions) then you probably have deductions or your company pays and you don't pay anything anyway. Remember Warren Buffet said "My secretary pays more income tax than I do". He's a Billionaire. So Obama care is good for working families and bad for the higher income and richer people. Just go to the website and put in different incomes and this is what it shows.

The mandate that people have insurance or pay a tax penalty is nothing but blackmail by our federal government. Now the I.R.S. Says It Will Reject Tax Returns That Lack Health Insurance Disclosure. It is not about having health insurance, which everyone should have, but how our government forces the american people to bend to their will. That is not democracy, it is autocratic which is are elected officials who make economic, social and political decisions without consent from the citizens.

I live alone in CA where Medicaid expansion is available. Expansion does not exist in Texas where family lives. I am onely 62, so Medicare for me starts in 3 yrs. I work in CA so must keep my job for stability. I cannot even move to family until I am old enough. My job is non-profit and "safe" that I have been told. Hopefully it will continue.

My kids have healthcare coverage because of the PPACA. The parents of many of my patients have healthcare coverage because of the PPACA. A good friend was able to get actual medical care instead of going occasionally to the charity clinic.

In my opinion, the PPACA should have been kept much more intact than it was when they even passed a version of it, and there should be no such thing as medical bankruptcy or people choosing between rent and food versus health care they need in a wealthy nation such as the USA.

Auto insurance is already mandatory. It is not that big a stretch to require health insurance. There are compelling reasons to do so.

Auto insurance is not exactly mandatory. In my state, you are required to carry liability insurance or prove financial responsibility in order to license your vehicle. Other coverages are optional. You can choose to carry collision, comprehensive, uninsured or underinsured driver coverage. You can also control the amount of your premiums by choosing a vehicle that is less expensive to insure, or you can eliminate premiums totally by having no vehicle at all. I think that many people who dislike the ACA feel that they should be able to decide what coverages, and what level of coverage they wish to purchase. The ACA mandates what the policies cover, thus raising the price of premiums.